Senior Claims Representative

Dayforce

Senior Claims Representative managing high-exposure workers’ compensation claims at MEM Insurance. Conducting investigations and overseeing medical case management while mentoring junior adjusters.

Posted 7/29/2026full-timeRemote • Illinois, Iowa, Kansas, Montana, New York, Tennessee • 🇺🇸 United StatesSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing complex claims with significant financial exposure, conducting advanced investigations, and overseeing medical case management. Proficient in negotiating settlements, ensuring compliance, and leading cross-departmental initiatives to enhance claims handling.

Highest-signal resume keywords

Claims ManagementAdvanced InvestigationsMedical Case ManagementNegotiation SkillsWorkers’ Compensation Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims HandlingStatutory InterpretationBenefit CalculationsSubrogation AnalysisFraud InvestigationMedicare ComplianceData Integrity ManagementStrategic ReportingWorkflow ImprovementCost Control

Soft Skills

MentoringCustomer ServiceCollaborationLeadershipCommunication

Certifications & Qualifications

Associate in Claims (AIC)AIMCPCUTexas All-Lines License

Industry Keywords

Workers’ CompensationClaims StrategyLitigation ManagementStructured SettlementsRisk Management

About the role

Key responsibilities & impact

Manage highly complex claims involving significant financial exposure, legal intricacies, and extended life cycles.
Conduct advanced investigations into coverage and compensability, including nuanced statutory interpretations.
Oversee medical case management for catastrophic injuries and lifetime care needs.
Review and authorize large or complex medical bills, negotiating adjustments to control costs.
Develop comprehensive RTW strategies in collaboration with policyholders, legal counsel, and vocational consultants.
Ensure precision in benefit calculations for high-exposure claims, addressing tax and compliance risks.
Strategically deploy investigative efforts aligned with broader claims strategy.
Lead investigations into complex fraud cases and collaborate with the Special Investigations Unit.
Conduct subrogation analysis and negotiate with third-party insurers or attorneys for maximum recovery.
Partner with legal teams to negotiate complex settlements and manage litigation processes.
Oversee Medicare compliance initiatives, including Medicare Set-Asides and CMS engagement.
Identify opportunities for structured settlements and lead negotiations.
Produce strategic reports on high-profile claims to guide management decisions.
Maintain system data integrity and prepare claims for Corporate Plan of Action meetings.
Lead cross-departmental efforts to improve claims handling and risk management.
Resolve escalated customer service issues and support high-value accounts.
Participate in workflow improvement initiatives and committees.
Mentor and coach junior and intermediate adjusters.
Review escalated claims and provide actionable feedback.
Support workforce development and succession planning.

Requirements

What you’ll need

Bachelor’s degree in business or related field preferred, or equivalent industry experience.
7–10 years of claims handling experience, with high exposure to Workers’ Compensation.
Associate in Claims (AIC), AIM, or CPCU designation preferred or ability to obtain.
Texas All-Lines license preferred.
Valid driver’s license required.

Benefits

Comp & perks

Health Plans: Medical, Dental, and Vision
Employer-Paid Life and Disability Benefits:Life Insurance (3x base salary), AD&D, Short and Long-term Disability.
Wellness and Recognition Program: Employer-paid incentives for employees and spouses.
Flexible Spending Account and Dependent Care options
Health Savings Account: Generous employer contribution.
Time Away from Work:Generous PTO, 11 Holidays + 4 Early Releases, 16 Hours Volunteer Time Off, 20 Days Paid Parental Leave, Marriage, Bereavement, and Jury Duty leave.
Employee Assistance Programs
401k Retirement Plan: Employer match and profit sharing.
Adoption Assistance and Tuition Assistance